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CONVENTION 2022 SUCCESS THROUGH SYNERGY (Constant Contact)

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CONVENTION 2022
SUCCESS THROUGH SYNERGY
INNOVATION, INSPIRATION & TRANSFORMATION
REGISTRATION FORM NEW DATES | 10th - 13th May 2022
Member Name
Member Company
Email Address
Mobile Number
I would like to attend the outsource Financial Convention.
(Educational seminars and evening events are for outsource members only).
How many guests will be staying in your room? e.g. 1 adult, 2 adults & 2 kids, etc.
Adults
Kids
If you would like to book extra days prior to, or after the Convention, please list the dates you require
in the box below. (Extra days are at your own cost - $199 per night).
Please indicate below, how you would like to pay the fee of $600 + GST.
Please deduct the fee of $600 + GST from my next commission payment.
I would like to pay by direct debit (please complete the relevant section on page 2).
I would like to pay by credit card (please complete the relevant section on page 2).
Please advise us of any dietary requirements, restrictions, or allergies:
DIRECT DEBIT REQUEST (DDR) /
CREDIT CARD REQUEST
Our contact details – outsource Financial Pty Ltd (314011), 406/19 Roseby Street, Drummoyne 2047
PART A – Cheque/Savings Account or Credit Card Authorisation
I/We request and authorise OUTSOURCE FINANCIAL PTY LTD (314011) to arrange, through its own financial
institution, a debit to your nominated account any amount OUTSOURCE FINANCIAL PTY LTD (314011), has deemed
payable by you. This debit or charge will be made through the Bulk Electronic Clearing System (BECS) from your
account held at the financial institution you have nominated below and will be subject to the terms and conditions of the
Direct Debit Request Service Agreement.
Financial Institution
Account Name
BSB Number
-
Account Number
I/We request and authorise Acknowledgement. By signing and/or providing us with a valid instruction in respect to
your Direct Debit Request, you have understood and agreed to the terms and conditions governing the debit
arrangements between you and OUTSOURCE FINANCIAL PTY LTD as set out in this Request and in your Direct Debit
Request Service Agreement.
OR
I request you OUTSOURCE FINANCIAL PTY LTD to arrange for funds to be debited from my nominated credit card
according to the schedule specified above and attached Direct Debit Service Agreement.
Card Holder Name
Expiry Date
/
Card Number
Surcharges: Credit Card 1.35% or Bank Account AUD 0.88
Signature 1: _____________________________________________ Date: _______________________
Signature 2: _____________________________________________ Date: _______________________
Please return this completed form to conference@outsourcefinancial.com.au to secure your
booking.
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CONVENTION 2022 SUCCESS THROUGH SYNERGY (Constant Contact)

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Completed 4 March 2022

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